Provider Demographics
NPI:1033411871
Name:CSI-ELDERLY SERVICES, INC.
Entity Type:Organization
Organization Name:CSI-ELDERLY SERVICES, INC.
Other - Org Name:CSI-CAREGIVER SERVICES OF TENNESSEE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SODERQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-500-0397
Mailing Address - Street 1:602 W COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-3540
Mailing Address - Country:US
Mailing Address - Phone:615-848-0114
Mailing Address - Fax:615-848-3016
Practice Address - Street 1:602 W COLLEGE ST
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-3540
Practice Address - Country:US
Practice Address - Phone:615-848-0114
Practice Address - Fax:615-848-3016
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAREGIVER SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-30
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NA253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0445778OtherTENNCARE PROVIDER NUMBER (MEDICAID)